P81770 PhillippeDAVIE COUNTY HEALTH DEPARTPIENT SEPTIC TANK PERMIT
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.
No of Bedrooms f 4: a
Date
This permit is granted to
for the i tallation of a septic tank
at the residence of�`
Address ( �
Building Contractor "`"
Address
Septic Tank Specifications: Length
Width Depth Capacity Gal.
�cro-,`p
nSZd
Manufacturer's Name Si(r
Addressi
No of lines_ width/in. Total
Length y0oft. No. of Sq. Ft.
Type of filter material �L�r2�
Total tons used
Minimum Requirements: House Trailer
Tank Cap. 800 Sq. ft. line 100
Two --bedroom house 800 600
Three-bedroom house 900 900
No one shall install a septic tank in
Davie County without a permit from the Health
Officer or his agent.
Date of final approval
Signed: _
Sanitarian
I hereby certify that the above septic
tank has been installed according to
specifications.
Signed:- —�`—�
Septic Tank Contractor
Note: Make sketch of disposal system on back of sheet and mail to Health Center,
Mocksville.